Pearls From: Edward Kim, MD

Can precision medicine make NSCLC a chronic condition?

A series of incremental outcome improvements, primarily in progression-free survival, have helped increase the lifespan of patients with non-small cell lung cancer. Much of the credit should go to the evolution of precision medicine and use of targeted therapies, driven by improved understanding of the molecular and genetic makeup of tumors.

In this exclusive MedPage Today video, Edward Kim, MD, of the Carolinas HealthCare System Levine Cancer Institute in Charlotte, N.C., reviews the progress and discusses the future challenges in reaching the goal of transforming lung cancer into a chronic disease.

Following is a transcript of Kim's comments.

We are seeing this explosion in precision medicine and that is what's really exciting, not just for clinicians, for scientists, but mostly for patients now, and we're seeing this really translate into the clinic. Several trials reported over the last several years and as recent as a couple months ago have demonstrated that if we test for a certain marker in a patient's tumor we can find an appropriate drug that matches up to it, and thus allows us to give a drug that has less overall side effects and has greater potency or efficacy, and so it's a win-win truly.

Multiple examples have existed in lung cancer. There was first the EGFR mutation, the epidermal growth factor receptor mutation, and we found this mutation was very sensitive to a class of drugs, these TKIs, or tyrosine kinase inhibitors, that we have multiple ones approved right now. These all target these sensitive mutations and patients' tumors literally shrink down, and they live longer taking a pill, as opposed to systemic chemotherapy.

This was later followed by another class of drugs called ALK, of which we have several also FDA approved. Later, we found out ROS1 also was a sensitizing area, and most recently in the whole immunotherapy wave, which has really come into play in lung cancer on a very practical and dynamic way, is PD-L1. Now, we currently screen patients who have non-small cell lung cancer for PD-L1 expression. If we find that the expression level is high, meaning greater than 50%, we treat them with one of the PD-1 inhibitors, checkpoint inhibitors, and they can take this as a single agent drug as opposed to two-drug, cytotoxic chemotherapy.

So, it's really been just unbelievable how many precision medicine initiatives have been incorporated into the care of lung cancer patients, and they're benefiting. This is also the kind of experience they're having with these other TKIs, and that combined, including the EGFR, the ALK, the ROS1, and the PDL-1 expression, encompasses almost 50% of our patients. So, were getting there.

Back when I started in the early 2000's, we had zero biomarkers for lung cancer, and now almost half the population can benefit from a targeted therapy. So, it has been really exciting to see how important a biopsy and getting the appropriate tests [can] help with the staging. It's no longer just about whether it's in your bones or your liver, or whether it's involved with other places; it's really important to assess not only where the disease is, but what are the markers that are unique to each individual's tumor.